Semilunar valve switch procedure: Autotransplantation of the native aorticvalve to the pulmonary position in the Ross procedure

Background. The Ross procedure has gained wide acceptance in young patients with aortic valve disease. The durability of the pulmonary autograft in th e aortic position has been proved, with up to 24 years of followup. The hom ograft pulmonary valve, however, has limited longevity. To circumvent this problem we harvested, repaired, and reimplanted the native aortic valve wit h intact commissures in the pulmonary position in 13 patients undergoing th e Ross procedure for aortic insufficiency. Methods. The cause of aortic insufficiency was rheumatic in 6 patients, con genital in 4, post-aortic valvotomy in 2, and bacterial endocarditis in 1. Patient age ranged from 5 to 45 years (mean, 17 +/- 9 years). Root replacem ent technique with coronary artery reimplantation was used. In the first 4 patients, the native aortic valve was sutured into the right ventricular ou tflow tract, and a polytetrafluorethylene patch was used to reconstruct the main pulmonary artery. In the last 9 patients, the aortic valve and polyte trafluorethylene patch were made into a conduit by another surgeon while th e left-sided reconstruction was performed. Results. All patients had marked reduction of left ventricular dilation and good function of the reim-planted native aortic valve, with up to 50 month s of follow-up (mean, 29.9 +/- 14.2 months; range, 12 to 50 months). Two pa tients died 15 and 26 days, respectively, of a false aneurysm rupture at th e distal aortic anastomosis. In the remaining 11 patients, 9 (82%) had mild or absent, and 2 (18%) had mild to moderate, neoaortic valve regurgitation . Similarly, 9 patients (82%) had mild or absent, and 2 (18%) had mild to m oderate, neopulmonary valve regurgitation. Mild neopulmonary valve stenosis was present in 6 patients (54%) (mean gradient, 29 +/- 4 mm Hg; range, 25 to 35 mm Hg). All surviving patients are in functional New York Heart Assoc iation functional class I. Conclusions. We conclude that use of the native aortic valve with the Ross procedure makes the procedure attractive and potentially curative. The dise ased aortic valve works well in the pulmonary position because of lower pre ssure and resistance. The valve leaflets should remain viable and grow in b oth the pulmonary and aortic positions because they derive nutrition direct ly from the blood. (Ann Thorac Surg 1999;67:745-50) (C) 1999 by The Society of Thoracic Surgeons.